Federal officials are receiving plenty of opposition to Florida's plan to move 3 million Medicaid patients into managed-care plans, but Collier Health Services has a different perspective.

Officials with the nonprofit clinic operations in Immokalee and greater Naples launched their own Medicaid managed-care program last year and intend to pursue state contracts when Florida moves to mandatory enrollment statewide in 2014.

That's assuming the federal Centers for Medicare and Medicaid approves the state's plan. The Florida Agency for Health Care Administration faces an Aug. 1 deadline for submitting its proposal.

For the past five years, a pilot managed-care program with Medicaid has operated in five counties, mostly in South Florida.

"All of us are against (managed care). The problem is this is just reality," said Richard Akin, chief executive officer of Collier Health Services (CHS), adding that the state's decision this past spring to move toward managed care for Medicaid was inevitable.

With program costs now at $22 billion and climbing, the same as with enrollment, state lawmakers had to act before the health insurance program for children, the elderly and disabled absorbed even more of the budget, he said.

After four years of organizing its managed-care program, CHS launched Integral Quality Care last year and secured a state contract in April 2010 to serve Collier County's Medicaid clients. Enrollment, nonetheless, was optional.

"All of us are against (managed care). The problem is this is just reality," said Richard Akin, chief executive officer of Collier Health Services.

Akin said Integral will pursue additional contracts once it rolls out statewide. He estimates Integral has about 20,000 patients enrolled so far.

"We are planning to bid in a whole lot more than in Collier," Akin said.

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From the perspective of many medical and consumer groups, the state's move to mandatory Medicaid managed care enrollment is troubling, according to Florida CHAIN, a leading consumer health-care watchdog group with an acronym that stands for Community Health Action Information Network.

Earlier this week, 107 entities in the state, from pediatric, mental health and elder-care groups, signed off on a letter to the Centers for Medicare and Medicaid objecting to the state's plan. Five county-based medical associations signed the letter, including the Lee County Medical Society.

"We're always concerned patients may not be able to get the care they need," said Dr. Emad Salman, a pediatric oncologist and medical director of The Children's Hospital of Southwest Florida in Fort Myers.

Earlier this week, 107 entities in the state, from pediatric, mental health and elder-care groups, signed off on a letter to the Centers for Medicare and Medicaid objecting to the state's plan.

Five county-based medical associations signed the letter, including the Lee County Medical Society.

Delays in getting approvals for tests have meant staff members spend considerable time on the phone, which isn't a good use of resources, he said.

"It is frustrating," Salman said, but added the move to managed care for Medicaid was inevitable to help control costs.

The Collier County Medical Society didn't sign the Florida CHAIN letter but eight local doctors will be attending the annual meeting of the Florida Medical Association (FMA) this weekend in Orlando, said Margaret Eadington, executive director of the Collier society.

The FMA earlier came out against the state's move to managed care for Medicaid.

Among the issues for those groups that signed the Florida CHAIN letter is the state's intent to allow insurers to design and reduce benefits as opposed to a dependable benefits plan. Another concern is reducing fixed reimbursement so it is 5 percent below what would have been the projected fee-for-service spending.

Another concern is the fast turn-around of 2014 to start, given the patient population of children, the elderly and disabled, are so vulnerable.

Florida CHAIN also says protections for children, pregnant women, seniors and the disabled are lacking, and the state's intent to charge unaffordable premiums and co-payments conflicts with federal law.